The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever

Giovanna Stringari, Salvatore Tripodi, Carlo Caffarelli, Arianna Dondi, Riccardo Asero, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Giampaolo Ricci, Federica Bellini, Nunzia Maiello, Michele Miraglia Del Giudice, Tullio Frediani, Simona Sodano, Iride Dello Iacono, Francesco Macrì, Ilaria Peparini, Carlotta Povesi Dascola, Maria Francesca Patria, Elena VarinDiego Peroni, Pasquale Comberiati, Loredana Chini, Viviana Moschese, Sandra Lucarelli, Roberto Bernardini, Giuseppe Pingitore, Umberto Pelosi, Mariangela Tosca, Anastasia Cirisano, Diego Faggian, Alessandro Travaglini, Mario Plebani, Paolo Maria Matricardi

Research output: Contribution to journalArticle

Abstract

Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume134
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Seasonal Allergic Rhinitis
Pollen
Immunotherapy
Prescriptions
Skin Tests
Profilins
Betulaceae
Parietaria
Cupressus
Immunoglobulin E
Artemisia
Olea
Poaceae
Pediatrics
Art
Ambulatory Care Facilities
Allergens
Guidelines
Allergic Rhinitis

Keywords

  • Allergic rhinitis
  • children
  • component-resolved diagnosis
  • IgE
  • panallergens
  • pollen
  • profilin
  • specific immunotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

Cite this

Stringari, G., Tripodi, S., Caffarelli, C., Dondi, A., Asero, R., Di Rienzo Businco, A., ... Matricardi, P. M. (2014). The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. Journal of Allergy and Clinical Immunology, 134(1). https://doi.org/10.1016/j.jaci.2014.01.042

The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. / Stringari, Giovanna; Tripodi, Salvatore; Caffarelli, Carlo; Dondi, Arianna; Asero, Riccardo; Di Rienzo Businco, Andrea; Bianchi, Annamaria; Candelotti, Paolo; Ricci, Giampaolo; Bellini, Federica; Maiello, Nunzia; Miraglia Del Giudice, Michele; Frediani, Tullio; Sodano, Simona; Dello Iacono, Iride; Macrì, Francesco; Peparini, Ilaria; Povesi Dascola, Carlotta; Patria, Maria Francesca; Varin, Elena; Peroni, Diego; Comberiati, Pasquale; Chini, Loredana; Moschese, Viviana; Lucarelli, Sandra; Bernardini, Roberto; Pingitore, Giuseppe; Pelosi, Umberto; Tosca, Mariangela; Cirisano, Anastasia; Faggian, Diego; Travaglini, Alessandro; Plebani, Mario; Matricardi, Paolo Maria.

In: Journal of Allergy and Clinical Immunology, Vol. 134, No. 1, 2014.

Research output: Contribution to journalArticle

Stringari, G, Tripodi, S, Caffarelli, C, Dondi, A, Asero, R, Di Rienzo Businco, A, Bianchi, A, Candelotti, P, Ricci, G, Bellini, F, Maiello, N, Miraglia Del Giudice, M, Frediani, T, Sodano, S, Dello Iacono, I, Macrì, F, Peparini, I, Povesi Dascola, C, Patria, MF, Varin, E, Peroni, D, Comberiati, P, Chini, L, Moschese, V, Lucarelli, S, Bernardini, R, Pingitore, G, Pelosi, U, Tosca, M, Cirisano, A, Faggian, D, Travaglini, A, Plebani, M & Matricardi, PM 2014, 'The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever', Journal of Allergy and Clinical Immunology, vol. 134, no. 1. https://doi.org/10.1016/j.jaci.2014.01.042
Stringari, Giovanna ; Tripodi, Salvatore ; Caffarelli, Carlo ; Dondi, Arianna ; Asero, Riccardo ; Di Rienzo Businco, Andrea ; Bianchi, Annamaria ; Candelotti, Paolo ; Ricci, Giampaolo ; Bellini, Federica ; Maiello, Nunzia ; Miraglia Del Giudice, Michele ; Frediani, Tullio ; Sodano, Simona ; Dello Iacono, Iride ; Macrì, Francesco ; Peparini, Ilaria ; Povesi Dascola, Carlotta ; Patria, Maria Francesca ; Varin, Elena ; Peroni, Diego ; Comberiati, Pasquale ; Chini, Loredana ; Moschese, Viviana ; Lucarelli, Sandra ; Bernardini, Roberto ; Pingitore, Giuseppe ; Pelosi, Umberto ; Tosca, Mariangela ; Cirisano, Anastasia ; Faggian, Diego ; Travaglini, Alessandro ; Plebani, Mario ; Matricardi, Paolo Maria. / The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. In: Journal of Allergy and Clinical Immunology. 2014 ; Vol. 134, No. 1.
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abstract = "Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69{\%}]), Betulaceae (146/252 [60{\%}]), pellitory (78/257 [30{\%}]), olive (111/390 [28{\%}]), cypress (28/184 [15{\%}]), and grass (56/568 [10{\%}]). IgE to profilins, polcalcins, or both could justify 173 (37{\%}) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42{\%}) of 651 or 315 (48{\%}) of 651 children according to the European or American approach, respectively, and in 305 (47{\%}) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.",
keywords = "Allergic rhinitis, children, component-resolved diagnosis, IgE, panallergens, pollen, profilin, specific immunotherapy",
author = "Giovanna Stringari and Salvatore Tripodi and Carlo Caffarelli and Arianna Dondi and Riccardo Asero and {Di Rienzo Businco}, Andrea and Annamaria Bianchi and Paolo Candelotti and Giampaolo Ricci and Federica Bellini and Nunzia Maiello and {Miraglia Del Giudice}, Michele and Tullio Frediani and Simona Sodano and {Dello Iacono}, Iride and Francesco Macr{\`i} and Ilaria Peparini and {Povesi Dascola}, Carlotta and Patria, {Maria Francesca} and Elena Varin and Diego Peroni and Pasquale Comberiati and Loredana Chini and Viviana Moschese and Sandra Lucarelli and Roberto Bernardini and Giuseppe Pingitore and Umberto Pelosi and Mariangela Tosca and Anastasia Cirisano and Diego Faggian and Alessandro Travaglini and Mario Plebani and Matricardi, {Paolo Maria}",
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language = "English",
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journal = "Journal of Allergy and Clinical Immunology",
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TY - JOUR

T1 - The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever

AU - Stringari, Giovanna

AU - Tripodi, Salvatore

AU - Caffarelli, Carlo

AU - Dondi, Arianna

AU - Asero, Riccardo

AU - Di Rienzo Businco, Andrea

AU - Bianchi, Annamaria

AU - Candelotti, Paolo

AU - Ricci, Giampaolo

AU - Bellini, Federica

AU - Maiello, Nunzia

AU - Miraglia Del Giudice, Michele

AU - Frediani, Tullio

AU - Sodano, Simona

AU - Dello Iacono, Iride

AU - Macrì, Francesco

AU - Peparini, Ilaria

AU - Povesi Dascola, Carlotta

AU - Patria, Maria Francesca

AU - Varin, Elena

AU - Peroni, Diego

AU - Comberiati, Pasquale

AU - Chini, Loredana

AU - Moschese, Viviana

AU - Lucarelli, Sandra

AU - Bernardini, Roberto

AU - Pingitore, Giuseppe

AU - Pelosi, Umberto

AU - Tosca, Mariangela

AU - Cirisano, Anastasia

AU - Faggian, Diego

AU - Travaglini, Alessandro

AU - Plebani, Mario

AU - Matricardi, Paolo Maria

PY - 2014

Y1 - 2014

N2 - Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.

AB - Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.

KW - Allergic rhinitis

KW - children

KW - component-resolved diagnosis

KW - IgE

KW - panallergens

KW - pollen

KW - profilin

KW - specific immunotherapy

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